发声训练在电子喉镜下手术治疗声带良性病变及嗓音康复的应用

目的探讨发声训练在电子喉镜下手术治疗声带良性病变对嗓音康复的效果。方法将符合入组的400例患者随机分为两组,A组200例为实验组,B组200例为对照组。对照组采用常规方法,实验组在常规方法的基础上实施系统的发声训练。并于手术后1、3、6个月返院回访,行电子喉镜检查及嗓音主观听感知分析(听觉)进行效果评价。结果术后1个月,A、B两组患者术后恢复状况差异无显著意义(P0.05)。术后3个月、6个月,两组嗓音康复情况与电子喉镜复查结果差异有显著意义(P0.001)。结论发声训练对电子喉镜下手术治疗声带良性病变患者的嗓音康复有效。     

护理干预在声带息肉患者术后嗓音康复中的应用

目的:探讨规范化护理干预在声带息肉患者术后嗓音恢复中的应用。方法:将120例在电视监视支撑喉内窥镜下行声带息肉摘除术的患者随机分为干预组和对照组各60例。对照组术后按照耳鼻咽喉科护理常规给予雾化吸入;干预组在对照组基础上实施规范化护理干预,包括心理干预、禁声、禁烟酒、嗓音发声训练等。术后3个月通过纤维喉镜检查和视觉模拟评分法,评估患者嗓音恢复情况。结果:两组患者术后3个月纤维喉镜检查和喉自主发声能力评估比较差异有统计学意义(P<0.01)。结论:对声带息肉术后患者实施规范化护理干预可有效促进患者嗓音康复,提高其发音质量。     

系统性嗓音训练对甲状腺术后无喉返神经损伤患者语言功能的影响

目的:探讨系统性嗓音训练对甲状腺术后无喉返神经损伤患者语言功能的影响。方法:将2020年1月1日～2021年1月31日收治的84例行甲状腺手术治疗且术后无喉返神经损伤的患者随机分对照组和观察组各42例。对照组采用常规护理干预,观察组在对照组基础上采用系统性嗓音训练。比较两组客观嗓音声学参数和主观嗓音质量评分[采用嗓音障碍指数量表(VHI)]。结果:观察组基频(Fo)、嗓音障碍严重指数(DSI)、最长发音时间(MPT)高于对照组(P0.01),且基频微扰(jitter)、振幅微扰(shimmer)低于对照组(P0.05);观察组VHI各项评分及总分均低于对照组(P0.01)。结论:对甲状腺术后无喉返神经损伤患者采用系统性嗓音训练干预,可改善患者嗓音声学参数,提升患者主观嗓音质量,促进患者语言功能恢复。     

支撑喉镜下显微手术对声带息肉患者术后康复及嗓音学指标的影响

目的 探讨支撑喉镜下显微手术对声带息肉患者术后康复及嗓音学指标的影响。方法 选取2017年1月～2019年1月我院收治的70例声带息肉患者,分为对照组和观察组各35例。对照组采用纤维喉镜下声带息肉切除术,观察组采用支撑喉镜下显微手术,比较两组临床疗效、临床指标及嗓音学指标。结果 观察组治疗总有效率为97.14%,高于对照组的77.14%,差异有统计学意义(P0.05);观察组声音恢复时间、手术时间及首次发声时间均短于对照组,术中出血量少于对照组(P0.05);两组基频微扰、声门嗓音能量(NNE)、术后振幅微扰均低于术前,且观察组显著低于对照组对照组(P0.05)。结论 声带息肉患者采用支撑喉镜下显微手术治疗的疗效显著,嗓音功能恢复较好,可促进术后康复。     

内镜下应用新型组织工程材料修复喉返神经损伤引起的声带麻痹的效果

目的 探讨内镜下应用新型组织工程材料修复喉返神经损伤引起的声带固定的效果。方法选取上海市胸科医院患者10例。其中，男6例，女4例，平均（63.00±9.00）岁，均为胸外科术后出现声音嘶哑症状，喉镜或食管镜证实为声带麻痹。在喉镜/食管镜下使用脱细胞真皮基质注射喉成形术治疗声带麻痹，采用嗓音障碍指数（VHI）和嗓音相关生活质量（V-RQOL）量表评估患者术前、术后3、10、20和30 d的嗓音功能。结果 手术过程顺利，患者无过敏，术后无出血等并发症。90%(9/10)的患者VHI有改善，100%(10/10)的患者在治疗后V-RQOL有所改善。趋势回归分析发现，在接受手术治疗后，VHI和V-RQOL都有下降趋势。术后随访1年，所有患者嗓音恢复良好，其V-RQOL最低。结论 脱细胞真皮基质注射喉成形术，可以有效、安全地治疗因喉返神经损伤引起声带麻痹所致的喉功能不全，值得临床应用。     

发声训练对支撑喉镜下手术治疗声带良性病变患者术后嗓音康复的影响

目的探讨发声训练对支撑喉镜下手术治疗声带良性病变患者术后嗓音康复的影响。方法选择2014年8月~2016年5月我科收治的支撑喉镜下手术治疗声带良性病变患者120例作为研究对象,根据术后治疗的方式分为对照组和实验组,每组60例。对照组术后给予常规治疗。实验组在对照组的基础上进行发声训练。比较治疗后嗓音康复的情况。结果两组术后1个月声音质量相近,差异无统计学意义(P0.05),实验组术后3、6个月声音质量恢复显著优于对照组,差异有统计学意义(P0.05)。两组电子喉镜检查结果比较差异无统计学意义(P0.05)。结论支撑喉镜下手术治疗声带良性病变的患者,术后可以进行发声训练,能够显著提高患者声音质量,促进声带的恢复,具有临床应用的价值。     

微波手术治疗早期声门型喉癌6例观察体会

目的 观察支撑喉镜下微波治疗早期声门型喉癌的效果.方法 采用微波治疗仪在支撑喉镜下对6例早期声门型喉癌患者进行显微手术治疗.6例均在全身麻醉下进行.术前、术后经电子喉镜检查声带,评估声带功能.结果 6例患者术后3个月,6个月,12个月门诊电子喉镜复查均无肿瘤复发.6例患者均保留了喉发声功能.结论 微波手术治疗早期声门癌创伤小、恢复快、手术及住院时间短,喉发生功能保护较好.     

高压氧治疗甲状腺癌术后双侧喉返神经损伤一例护理

喉返神经损伤是甲状腺手术常见的并发症,其中永久性损伤占1%～2%,而暂时性损伤高达5%～6%[1]。双侧喉返神经损伤引起双侧声带麻痹造成气道阻塞,处理不当将造成严重后果。我科于2015年4月收治一例患者甲状腺癌术后出现双侧喉返神经损伤,采用高压氧等综合治疗后恢复。高压氧是神经康复治疗较常用手段之一, 其对受损神经恢复的积极作用已得到基础及临床证实。目前治疗双侧喉返神经损伤以手术修复神经为主,而鲜有采用高压氧综合治疗的报道[2],故将护理体会报道如下。     

被膜解剖技术用于甲状腺全切除术

目的：介绍应用精细化被膜解剖技术行甲状腺全切除术治疗甲状腺疾病的体会。方法：回顾分析应用精细化被膜解剖技术行甲状腺全切术治疗132例甲状腺良性或恶性疾病患者的临床资料。结果：发生暂时性甲状旁腺功能低下症4例,在术后4周内恢复;发生暂时性喉返神经麻痹1例,在术后3个月内恢复;无发生永久性甲状旁腺功能低下症、永久性喉返神经损伤和永久性喉上神经损伤病例。结论：应用精细化被膜解剖技术行甲状腺全切术有效避免了永久性甲状旁腺功能低下症、喉返神经和喉上神经损伤并发症的发生。     

甲状腺手术中喉返神经损伤的原因及预防

目的 探讨甲状腺手术中预防喉返神经损伤的方法.方法 回顾性分析223例甲状腺手术患者的临床资料,其中行喉返神经区域保护法69侧,常规解剖喉返神经法191侧.结果 喉返神经区域保护法损伤2例,其中暂时性损伤1例,考虑术中钳夹;永久性损伤1例,考虑术中结扎.常规解剖喉返神经法损伤1例,为暂时性损伤,考虑术后神经水肿,术后2个月恢复.喉返神经损伤率为1.35％.结论 甲状腺良性病变、病变位于非背侧,腺叶部分切除术,可行喉返神经区域保护法预防喉返神经损伤.甲状腺背侧病变、腺叶次全切除术、腺叶切除术、二次手术以及对侧喉返神经损伤患者,应常规解剖喉返神经预防损伤.依据不同病变及不同术式采取不同方法预防喉返神经损伤可明显减少喉返神经的损伤.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。